in 25 days Kaiser Permanente — Kaiser Northwest's Zepbound criteria move to the rev 9/10/2026 document — cite that version in an appeal from this date. No criterion changes: the two-oral step, the 6-month semaglutide trial, the BMI thresholds and the 12-month approval all carry over, so nothing you have to do to qualify is different See the changelog
WalletNoise

Ozempic® tablets (oral semaglutide) — 4 mg

Your cheapest verified route right now

verified price

$199 /month

NovoCare Pharmacy self-pay

Verified Oct 5, 2026 · novocare.com

Per year at 12 fills
$2,388
A plan exclusion is not the end. Under ACA rules you have 180 days to appeal, and secondary indications (sleep apnea for Zepbound, cardiovascular risk for Wegovy) run through different criteria. See your PBM's policy page.
Before your next appointment: at 9 mg your cheapest route (NovoCare Pharmacy self-pay) goes to $299/month — $100/month more than your current dose. WalletNoise shows the cost of a dose change, never whether to make one — that's your prescriber's call. Verified Oct 5, 2026 ·novocare.com
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Ozempic® tablets (oral semaglutide) has no manufacturer titration schedule in the corpus, so there is nothing here to price a climb against. WalletNoise will not assume one — a projection built on a guessed schedule is worse than no projection.

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    NovoCare Pharmacy self-pay

    $199/mo
    • Novo's direct channel. Free home delivery. Intro offers for new patients are time-limited.

    Verified Oct 5, 2026 · novocare.com

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